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Chapter 12 Bulimia 

Evidence Based Practices for Mental Health Professionals

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T



 After reading this section you will learn the answers to the following questions:

  1. What are the ICD-10-CM Codes for Bulimia?
  2. What are the clinical descriptors for Bulimia?
  3. What are the common symptoms for Bulimia?
  4. What are some common medical comorbidities of Bulimia?
  5. What are the common populations which are treated for Bulimia?
  6. What are the common treatment settings for Bulimia?
  7. What are the Evidence Based Practices for treating Bulimia?
  8. What area the common psychopharmacological treatments for Bulimia?
  9. What are some common manuals, guideline books and client workbooks for treating Bulimia?
  10. What are some good references you can use to learn more in-depth information about Bulimia?

ICD-10-CM Codes for Bulimia in DSM-5

F50.2 Bulimia Nervosa

F50.8 Binge-Eating Disorder

F50.8 Other Specified Feeding or Eating Disorder

F50.9 Unspecified Feeding or Eating Disorder


American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5). Washington, DC: Author.

Terry: Bulimia Nervosa

Terry was a sixteen year old Junior in High School and was becoming increasingly stuck in an active binge eating and then purging process on a daily basis. She would eat as much food as she could because she never felt satisfied with the amount of food she was taking in, however she was fearful of becoming obese due to this eating habit so she would either force herself to throw up or she would take laxatives to get the food out of her body as quickly as she could. Unfortunately this pattern of binging and purging was having a negative impact on her health and her parents had taken her to see her pediatrician who referred Terry for mental health counseling to deal with her bulimia nervosa.

Terry’s parents came to the first session and they shared that there has been a history of morbid obesity on both sides of their families and that they too had both fought periods of bulimia with binging and purging and just grew out of it. They had never had the medical problems now facing Terry which included: inflamed throat, lips, and esophagus as well as dental erosion and gum disease. She also was developing skin problems including dry skin and acne. Finally she was now having major gastrointestinal problems.

In meeting with Terry alone she admitted that her binging and purging were out of control and she had no idea what it would take to stop it. She was willing to work with me to stop this problem once and for all. You explain to her that the Cognitive Behavioral Therapy approach you are going to train her in has been well researched and documented as an effective treatment for her condition. You tell her, she will be given at least 12 sessions over the next six months. You give her first homework assignment which is to be brought back to your next session.

Bulimia Nervosa (BN) is closely allied with Binge-Eating Disorder (BED). Both conditions are marked by binge-like eating and BN also includes purging or other forms of voiding oneself of ingested food from the binging. Both are marked by the individual’s expectencies of thinness (thinness will improve social status and improve self-esteem), dietary restriction (dieting is a positive means to thinness) and the impact of binge eating (allieviate troubling and negative emotions) in one’s life (Bruce, Mansour and Steiger, 2009). Research has supported that people with BN have poor affective regulation and when they see food cues after fasting, it leads them to more binging (Mauler, Hamm, Weike and Tuschen-Caffier, 2006). Researchers have shown that people with BN have some cognitive impairments in terms of impulsivity and disinhibition (Zakzanis, Campbell and Polsinelli, 2010). They fail to react with awareness to the involved consequences, react irrationally to negative triggers in their life and are extremely self-critical and judgmental (Lavender, Gratz and Tull, 2011). People with BN also score low in self-forgiveness which just feeds the cognitive distortions which keep them stuck in moving out of the unhealthy cycles involved in this disorder (Watson, Lydecker, Jobe, Enright, Gartner, Mazzeo, and Worthingtion, 2012). 

Common mental health comorbidities with bulimia include: depression; bipolar disorder; panic disorder; social anxiety disorder/social phobia; PTSD; obsessive compulsive disorder and substance abuse (Woodside and Staab, 2006); ADHD (Seltz, Kahramen-Lanzerath, Legenbaurer, Sarrar, Herpertz, Salbach-Andrae, Konrad and Herpertz-Dahlmann, 2013); and Borderline Personality Disorder (Zeeck, Birindelli, Sandholz, Joos, Herzog and Hartmann, 2007).

There is a high percentage of depression with bulimia. The typical presentation of depression is a persistent depressive disorder typically known as dysthymia (Borda-Mas, Torres-Perez and del Rio-Sanchez, 2008). Recent studies have emphasized the comorbidity of Bulima with anxiety disorders (Swinbourne, Hunt, Abbott, Russll, St. Clare and Touyz, 2012).

There are medical comorbidities with bulimia nervosa-purging type with self-induced vomiting and over use of laxatives and/or diuretics. The medical cormobities of BN purging type include: 1) amenorrhea- up to 50% of women with Bulimia; 2) inflamed throat, lips, esophagus 3) dental complications of dental erosion and gum disease; 4) skin problems including dry skin, acne, loss of hair, eroding hand and feet nails; 5) gastrointestinal problems; 6) pulmonary difficulties; and 7) lightheadedness and dizziness and comorbidity for Binge Eating Disorder, including obesity (Mehler, 2011).

Populations with BN include:

1) Children and Adolescents (Le Grange and Schmidt, 2005; Resnick, 2005; Le Grange, 2010; Hughes, Goldschmidt, Labuschagne, Loeb, Sawyer and La Grange, 2013; Seltz, Kahramen-Lanzerath, Legenbaurer, Sarrar, Herpertz, Salbach-Andrae, Konrad and Herpertz-Dahlmann, 2013).

2) Adults (Murphy, Russell and Waller, 2005; Schaffner and Buchanan, 2010; Lavender, Startup, Naumann, Samarawickrema, Kenyon, van den Eynde and Schmidt, 2011; Sanchez-Ortiz, Munro, Startup, Treasure and Schmidt, 2011)

Evidenced Based Practices (EBPs) to treat Bulimia include:

1) Psychological Treatment only: Cogntive Behavior Therapy (CBT) or Interpersonal Psychotherapy (IPT) (Le Grange and Schmidt, 2005; Murphy, Russell and Waller, 2005; Resnick, 2005; Wilson, Grilo, Vitousek, 2007; Agras and Robinson, 2008; Fittig, Jocobi, Backmund, Gerlinghoff and Wilttchen, 2008; Hall, Friedman and Leach, 2008; Hardy and Thiels, 2008; Schaffner and Buchanan, 2008; Le Grange, 2010; Schaffner and Buchanan, 2010; Brown and Keel, 2012; Fursland, Byrne, Watson, LaPuma, Allen and Byrne, 2012;  Hay, 2013; Spielmans et al., 2013).

2) Family Therapy included in Outpatient Program (Schaffner and Buchanan, 2008; Le Grange, 2010; Schaffner and Buchanan, 2010).

3) Group Therapy included/or alone in Outpatient Program (Schaffner and Buchanan, 2008; Schaffner and Buchanan, 2010; Lavender, Startup, Naumann, Samarawickrema, Kenyon, van den Eynde and Schmidt, 2011; Jones and Clausen, 2013).

4) Technology: Internet based CBT individual treatment (Fernandez-Aranda et al., 2009; Sanchez-Ortiz, Munro, Startup, Treasure and Schmidt, 2011); Video games (Fagundo et al., 2013).

5) Self-Help Programs (Banasiak, Paxton and May, 2007; Sysko and Walsh, 2008).

6) Pharmacotherapy only (Bellini and Merli, 2004; Woodside and Staab, 2006; Agras and Robinson, 2008; Hall, Friedman and Leach, 2008; Viveros, Bermundez-Silva, Lopez-Rodriguezand Wagner, 2011; Brown and Keel, 2012; Mitchell, Roerig and Steffen, 2013).

7) Combination of Psychological and Pharmacotherapy (Bacaltchuck, Trefiglio, Oliveria, Hay, Lima and Mari, 2000; Agras and Robinson, 2008; Hall, Friedman and Leach, 2008; Brown and Keel, 2012).

Assignment for Terry after her first visit

The steps you can take to stop binging and purging?

In order to change an unwanted behavior you must follow the steps outlined below:

Step 1: You must make an honest assessment of your life style and behaviors and admit to yourself what behaviors you currently practice which are Binge and purging behaviors.

Step 2: You must be willing, on your own, to want to change the unhealthy binge, purging behaviors. Unless you want to change the behaviors for your own sake rather than to please someone else, you will lack the strength of motivation and conviction to follow through with the decision and behaviors needed to change.

Step 3: You must be willing to admit to yourself that to change this binge purging habit is a difficult task and you must be willing to set realistic goals for yourself.

Step 4: Once you identify the binging and purging behaviors to be changed, monitor yourself for the next month and keep a daily log of your behaviors. Each night put the log in your journal and answer the following questions for each occurrence of the target behaviors:

  1. How often did you engage in the binge purging behavior today?
  2. What did you do?
  3. What were the dimensions and size of the binge and purging behavior?
  4. How much time was spent on the behavior?
  5. Were there other people around or were you hiding?
  6. What was your emotional tone while you engaged in the behavior?
  7. Was there any significant event or cue preceding your engaging in this behavior?
  8. Where do you commonly engage in this behavior?
  9. How do you feel after you have completed this binge purging behavior?

Step 5: After you spend a month of daily logging in these target behaviors, look for a pattern present in the behaviors and determine:

  1. Location of behaviors, e.g., usually in home, kitchen, bar, work site, restaurant, etc.
  2. Time of day, e.g., usually in morning, evening, at lunch, after work, etc.
  3. Day of week, or month, e.g., on Fridays only, on pay days only, everyday, weekends only, etc.
  4. Length of time engaged in behavior, e.g., usually thirty minutes or less, six hours or more, etc.
  5. Emotional tone preceding engaging in the behavior, e.g., usually anxious, depressed, happy, stressed, etc.
  6. Emotional tone after engaging in the behavior, e.g., usually guilt, remorse, fear, depression, anger, disappointment, etc.
  7. Social environment where engaging in behavior, e.g., hiding, alone, with a specific person every time, in a social setting, etc.

Step 6: After you review the log and look for patterns, perform a behavior chain analysis on selected events to see if the patterns you identified in Step 5 can be further clarified or expanded upon.

Step 7: Now that your log, pattern analysis, and behavior chains are completed, determine which of these next corrective actions need to be taken:

  1. What needs to be restructured at home, at work and in the community to reduce the ease with which you engage in these behaviors? How can you make it more difficult for yourself to engage in these behaviors? How can you block yourself from freely engaging in these behaviors?
  2. What alterations need to be made in your daily, weekly and monthly schedule in order to reduce the opportunities for these target binging and purging behaviors to occur?
  3. What self‑monitoring or social support systems do you need to establish to help control or stop thinking about engaging in these binging and purging behaviors?
  4. What are some rational steps you can take to alter or control the impact of the emotional cues which typically lead to these behaviors? What thought‑stopping techniques do you need to use to avoid thinking about the behaviors?
  5. What do you need to do to continuously remind yourself of your humanity in attempting to change habitual ways of acting so that you are not hard on yourself if you "fall off the wagon?''
  6. What action plan can you set up to ensure you'll "jump back on the wagon'' after every failure?

Step 8: After answering the Step 7 issues, you are now ready to develop a plan of action to extinguish the target binge and purging behaviors. Set a realistic time frame. Be sure you have in place a support system to help you. Be sure you have ongoing review and re‑evaluation steps included in your plan.

Step 9: Implement your plan of action and monitor the results.

Step 10: If you are still unsuccessful, go back to Step 1 and begin again.

After reading these ten steps I am committed to working on eliminating my binge and purging behaviors

Signed:                                                       Date:

Adapted from: Section 3, Chapter 12: Handling Binging, Compulsive and Addictive Behaviors in Recovery in: Messina, J.J. (2013). Self-Esteem Seekers Anonymous-The SEA’s Program of Recovery, retrieved at

Medications used to treat Bulimia Nervosa


Drug Name (Generic Name)


Zofran (Ondansetron)

Potassium chloride

K-Dur,K-Lor,K-Tab,Micro-K (Potassium chloride)

Calcium gluconate

Calcium gluconate

Selective Serotonin Reuptake Inhibitors (SSRI)

Prozac (Fluoxetine)

Zoloft (Sertraline)

Paxil (Paroxetine)

Celexa (Citalopram)

Lexapro (Escitalopram)


Tegretol (Carbamazepine) Depakote (Valproic Acid, Divalproex Sodium) 
Neurontin (Gabapentin) 
Lamictal (Lamotrigine)
Trileptal (Oxcarbazepine) 
Gabitril (Tiagabine)
Topamax (Topiramate) 
Lyrica (Pregabalin)

In 2013, Hay reported after her research study into treating Bulimia Nervosa from 2005-2012, that “CBT had retained and extended its status as first-line therapy for BN” (p. 467). In 2012, Brown and Keel reported that after their exhaustive meta-analysis of research in treating Bulimia Nervosa that “both 60 mg fluoxetine (Prozac) (alone) and cognitive behavioral therapy (CBT) (alone) have well-established efficacy” (p. 50).

In reviewing over 47 studies (RTCs) in 2007, researchers found that medications alone (Fluoxetine-Prozac) decreased binge eating and purging symptoms and other psychological symptoms in the short term; whereas, CBT reduced behavioral and psychological symptoms in the short and long term. (Shapiro, Berkman, Brownley, Sedway, Lorh and Bulik, 2007). Studies also showed that using anticonvulsants helps reduce both binge eating and weight gain (Agras and Robinson, 2008).  There has been a body of support for combining psychological treatments along with using medications (Bacaltchuck, Trefiglio, Oliveria, Hay, Lima and Mari, 2000; Agras and Robinson, 2008; Hall, Friedman and Leach, 2008).

In day treatment or outpatient programs connected with hosptials or treatment centers there is often a combination of not only individual CBT or IPT, but also family therapy and group therapy (Schaffner and Buchanan, 2008). The family therapy educates the parents about Bulimia Nervosa, improves the family members’ communications skills with the target client, and provides emotional support to all family members so that they all are more capable of supporting the target client in dealing with this disorder (Schaffner and Buchanan, 2008).

Group therapy typically offers social and interpersonal skills building, emotional processing, nutritional education and an outlet to clarify the stressors involved in dealing with this condition (Schaffner and Buchanan, 2008; Schaffner and Buchanan, 2010). Because people with BN often lack motivation, are avoidant of uncomfortable experiences and lack experiental awareness of the reality in their lives, researchers have field tested a treatment approach called Acceptance and Commitment Therapy (ACT).  This could become an emerging alternative treatment approach (Jurascio, Shaw, Forman, Timko, Herbert, Butryn, Bunnell, Matteucci and Lowe, 2013).

Researchers did not find bulimia and/or binge eating self-help groups anymore effective for treating clients than individually held therapist sessions or group interventions (Sysko and Walsh, 2008). Spielmans et al. (2013) found that CBT was equally effective not just for Bulimia Nervosa but also for Binge Eating Disorder.

CBT psychological interventions, along with nutritional and weight reduction programming, have been successful methods to address Binge Eating Disorders (Wonderlich, Zwaan, Mitchell, Peterson and Crow, 2003).

Handouts for Terry to better explain the elements involved in her treatment

  1. TEA System
  2. ALERT System
  3. ANGER System
  4. LET GO System
  5. CHILD System
  6. RELAPSE System

All available online at: www. at:

Workbooks for Treating Bulimia Related Disorders

Agras, W.S. and Apple, R.F. (2008). Overcoming your eating disorder, A cognitive-behavioral therapy approach for bulimia nervosa and binge-eating disorder: Guided self-help workbook. New York: Oxford University Press


Albers, S. (2006) Mindful eating 101: A guide to healthy eating in college and beyond. New York: Routledge.


Apple, R.F., Lock, J. and Peebles, R. (2006) Preparing for weight loss surgery:Therapist guide. New York: Oxford University Press


Apple, R.F., Lock, J. and Peebles, R. (2006) Preparing for weight loss surgery: Workbook. New York: Oxford University Press


Cooper, M., Todd, G. and Wells, A. (2009). Treating bulimia nervosa and binge eating: An integrated metacognitive and cognitive therapy manual. New York: Routledge.


Grilo, C.M. and Mitchell, J.E. (2010). The treatment of eating disorders: A clinical handbook. New York: The Guildford Press.


Karasu, S.R. and Karasu, T.B. (2010). The gravity of weight: A clinical guide to weight loss and maintenance. Washington, DC: American Psychiatric Publishing Inc.


Kramer, G.F., Golden, R.N. and Peterson, F. (2009). The truth about eating disorders, second edition. New York: Facts on File, Inc.


Latner, J. and Wilson, G.T. (2007). Self-help approaches for obesity and eating disorders: Research and practice. New York: The Guilford Press.


Levitt, J.L., Sansone, R.A. and Cohn, L. (2004). Self-harm behavior and eating disorders: Dynamics, assessment, and treatment. New York: Brunner-Routledge.


Maj, M., Halmi, K., Lopez-Ibor, J.J. and Sartorius, N. (2003). Eating disorders. Chichester, West Sussex, England: John Wiley & Sons, LTD.


Messina, J.J. (2013). Tools for coping series: (1) Self-esteem seekers anonymous-The SEA’s program manual; (2) Laying the foundation: Personality traits of low self-esteem; (3) Tools for handling loss; (4) Tools for personal growth; (5) Tools for relationships; (6) Tools for communications; (7) Tools for anger work-out; (8) Tools for handling control issue; (9) Growing down:Tools for healing the inner child; (11) Tools for a balanced lifestyle, retrieved at


Mitchell, J.E., Devlin, M.J., deZwaan, M., Crow, S.J. and Peterson, C.B. (2008). Binge-eating disorder: Clinical foundations and treatment. New York: The Guilford Press.


Ogden, J. (2010). The psychology of eating: From health to disordered behavior, second edition. Chichester, West Sussex: Wiley-Blackwell.


Safer, D.L., Telch, C.F. and Chen, E.Y. (2009). Dialectical behavior therapy for binge eating and bulimia. New York: The Guilford Press.


Treasure, J., Schmidt, U. and Van Furth, E. (2003). Handbook of eating disorders, second edtion. Chichester, West Sussex, England: John Wiley & Sons, LTD.


Yager, J. and Powers, P (2007). Clinical manual of eating disorders. Washington, DC: American Psychiatric Publishing, Inc.

References for Bulimia

Agras, W.S. and Robinson, A.H. (2008). Forty years of progress in treatment of the eating

disorders. Nordic Journal of Psychiatry. 62, (47), 19-24.


Bacaltchuck, J., Trefiglio, R.P., Oliveria, I.R., Hay, P., Lima, M.S. and Mari, J.J. (2000).

Combinaton of antidepressants and psychological treatments for bulimia nervosa: A

systematic review. Acta Psychiatrica Scandinavica, 102, 256-267. 


Banasiak, S.J., Paxton, S.J. and May, P.J. (2007). Perceptions of cognitive behavioural guided

self-help treatment for bulimia nervosa in primary care. Eating Disorders, 1523-40. DOI: 10.1080/10640260601044444


Bellini, M., and Merli, M. (2004). Current drug treatment of patients with bulimia nervosa and

binge-eating disorder: Selective serotonin reuptake inhibitors versus mood stabilizers. International Journal of Psychiatry in Clinical Practice, 8(4), 235-243. doi: 10.1080/13651500410005621


Borda-Mas, M., Torres-Perez, I. and del Rio-Sanchez, C. (2008). Dysthymia in anorexia nervosa

and bulimia nervosa. International Journal of Clinical and Health Psychology, 8(1), 65-75.


Bowers, W. A. and Andersen, A. E. (2007). Cognitive-behavior therapy with eating disorders:

The role of medications in treatment. Journal of Cognitive Psychotherapy, 21, 16-27.


Brown, T.A. and Keel, P.K. (2012). Current and emerging directions in the treatment of eating

disorders. Substance Abuse: Research and Treatment, 6, 33-61. doi: 10.4137/SART.S7864.


Bruce, E., Mansour, S. and Steiger, H. (2009). Expectencies related to thinness, dietary

restriction, eating, and alcohol consumption in women with bulimia nervosa. International Journal of Eating Disorders, 42(3), 253-258.


Chakraborty, K. and Basu, D. (2010). Management of anorexia and bulimia nervosa: An

evidenced-based review. Indian Journal of Psychiatry, 52, 174-186. doi:10.4103/0019-5545.64596 


Fagundo, A.B., Santamaria, J.J., Forcano, L., Giner-Bartolome, C., Jimenez-Murcia, Sanchez, I.,

Granero, R., Ben-Mousse, M., Magnenat-Thalmann, N., Menchon, J.M, de la Torre, R., Cardi, V., Treasure, J. and Fernandez-Aranda, F. (2013). Video game therapy for emotional regulation and impulsivity control in a series of treated cases with bulimia nervosa. European Eating Disorders Review, 21, 493-499.


Fernandez-Aranda, F., Nunez, A, Martinez, C., King, I., Cappozzo, M., Carrard, I., Rouget, P.,

Jimenez-Murcia, S., Graner, R., Panelo, E., Santamaria, J., and Lam, T. (2009). Internet-based cognitive-behavioral therapy for bulimia nervosa: A controlled study. CyberPsychology and Behavior, 12(1), 37-41.  DOI: 10.1089/cpb.2008.0123


Fittig, E., Jocobi, C., Backmund, H., Gerlinghoff, M. and Wilttchen, H.U. (2008). Effectiveness

of day hospital treatment for anorexia nervosa and bulimia nervosa. European Eating Disorders Review, 16. 341-351. DOI: 10.1002/erv.883.


Fursland, A., Byrne, S., Watson, H., LaPuma, M., Allen, K. and Byrne, S. (2012). Enhanced

cognitive behavior therapy: A single treatment for all eating disorders. Journal of Counseling and Development, 90 (July), 319-329.


Hall, M., Friedman, J. and Leach, L. (2008). Treatment of bulimia nervosa. American Family

Physician, 77(11), 1588-1592.


Hardy, S.A. and Thiels, C. (2008). Using latent growth curve modeling in clinical treatment

research: An example comparing guided self-change and cognitive behavioral therapy treatments for bulimia nervosa. International Jouranl of Clinical and Health Psychology 9(1), 51-71.


Hay, P. (2013). A systematic review of evidence for psychological treatments in eating disorders:

2005-2012. International Journal of Eating Disorders, 46, 462-469. DOI: 10.1002/eat.22103


Hughes, E.K., Goldschmidt, A.B., Labuschagne, Z., Loeb, K.L., Sawyer, S.M. and La Grange,

D. (2013). Eating disorders with and without comorbid depression and anxiety: Similarities and differences in a clinical sample of children and adolescents. European Eating Disorders Review, 21386-394. DOI: 10.1002/erv.2234


Jones, A.L. and Clausen, L. (2013). The efficacy of a brief group CBT program in treating

patients diagnosed with bulimia nervosa: A brief report. International Journal of Eating Disorders, 46, 560-562. DOI: 10.1002/eat.22120


Juarscio, A., Shaw, J., Forman, E., Timko, C.A., Herbert, J., Butryn, M., Bunnell, D., Matteucci

and Lowe, M. (2013). Acceptance and commitment therapy as a novel treatment for eating disorders: An initial test of efficacy and mediation. Behavior Modification, 37(4), 459-489. DOI: 10.1177/0145445513478633


Keel, P.K. and Haedt, A. (2008). Evidence-based psychosocial treatments for eating problems

and eating disorders. Journal of Clinical Child and Adolescent Psychology, 37(1), 39-61. doi: 10.1080/15374410701817832 


Lavender, A., Startup, H., Naumann, U., Samarawickrema, N., Kenyon, M., van den Eynde, F.

and Schmidt, U. (2011). Emotional and social mind training: A randomized group trial of a new group-based treatment for bulimia nervosa. Plos ONE, 7(10), e46047. doi:10.1371/journal.pone.0046047


Lavender, J.M., Gratz, K.L. and Tull, M.T. (2011). Exploring the relationship between facets of

mindfulness and eating pathology in women. Cognitive Behaviour Therapy, 40(3), 174-182. DOI: 10.1080/16506073.2011.555485


Le Grange, D. (2010). Family-based treatment for adolescents with bulimia nervosa. The

Australian and New Zealand Journal of Family Therapy, 31(2), 165-175.


Le Grange, D. and Schmidt, U. (2005). The treatment of adolescents with bulimia

nervosa. Journal of Mental Health, 14(6), 587-597. doi: 10.1080/09638230500347905 


Lock, J. and Fitzpatrick, K.K. (2007). Evidence-based treatments for children and adolescents

with eating disorders: Family therapy and family-facilitated cognitive-behavioral therapy. Journal of Contemporary Psychotherapy, 37. 145-155. doi: 10.1007/s10879-007-9049-x 


Mauler, B.I., Hamm, A.O., Weike, A.I. and Tuschen-Caffier, B. (2006). Affect regulation and

food intake in bulimia nervosa: Emoitonal respoinding to food cues after deprivation and subsequent eating. Journal of Abnormal Psychology, 115(3), 567-579. DOI: 10.1037/0021-843X.115.3.567


Mehler, P.S. (2011). Medical complications of bulimia nervosa and their treatments.

International Journal of Eating Disorders, 44(2), 95-104


Mitchell, J.E., Roerig, J. and Steffen, K. (2013). Biological therapies for eating disorders.

International Journal of Eating Disorders, 46(5), 470-477. DOI: 10.1002/eat.22104


Murphy, S., Russell, L. and Waller, G. (2005). Integrated psychodynamic therapy for bulimia

nervosa and binge eating disorder: Theory, practice and preliminary findings. European Eating Disorders Review, 13, 383-391. DOI: 10.1002/erv.672


Resnick, J. L. (2005). Evidence-based practice for treatment of eating disorders.Journal of

College Student Psychotherapy, 20(1), 49-65.doi:10.1300/J035v20n01_05 


Sanchez-Ortiz, V.C., Munro, C., Startup, H., Treasure, J. and Schmidt, U. (2011). The role of

email guidance in internet-based cognitive behavioral self-care treatment for bulimia nervosa. European Eating Disorders Review, 19, 342-348. DOI: 10.1002/erv.1074


Schaffner, A.D. and Buchanan, L.P. (2008). Integrating evidence-based treatments with

individual needs in an outpatient facility for eating disorders. Eating Disorders, 16,378-392. DOI: 10.1080/10640260802370549


Schaffner, A.D. and Buchanan, L.P. (2010). Evidence-based practices for outpatient treatment of

eating disorders. International Journal of Behavioral Consultation and Therapy, 6(1), 35-44 


Seltz, J., Kahramen-Lanzerath, B., Legenbaurer, T., Sarrar, L., Herpertz, S., Salbach-Andrae, H.,

Konrad, K. and Herpertz-Dahlmann, B., (2013). The role of impulsivity, inattention and

comorbid ADHD in patients with bulimia nervosa. PLoS ONE, 8(5), e63891. doi:10.1371/journal.pone.0063891


Shapiro, J.R., Berkman, N.D., Brownley, K.A., Sedway, J.A., Lorh, K.N. and Bulik, C.M.

(2007). Bulimia nervosal treatment: A systematic review of randomized controlled trials. International Journal of Eating Disoreders 40, (4), 321-336. DOI 10.1002/eat


Spielmans, G.I., Benish, S.G., Marin, C., Bowman, W.M., Menster, M. and Wheeler, A.J.

(2013). Specificity of psychological treatments for bulimia nervosa and binge eating disorder? A meta-analysis of direct comparisons. Clinical Psychology Review, 33(3), 460-469. DOI: 10.1016/j.cpr.2013.01.008


Swinbourne, J., Hunt, C., Abbott, M., Russll, J., St. Clare, T. and Touyz, S. (2012). The

comorbidity between eating disorders and anxiety disorders: Prevalence in an eating disorder sample and anxiety disorder sample. Australian and New Zealand Journal of Psychiatry, 46 (2), 118-131.  DOI: 10.1177/0004867411432071


Sysko, R. and Walsh, B. T. (2008). A critical evaluation of the efficacy of self help for the

treatment of bulimia nervosa and binge-eating disorder. International Journal of Eating Disorders, 41(2), 97-112. doi: 10.1002/eat 


Viveros, M.P., Bermundez-Silva, F.J., Lopez-Rodriguez, A.B. and Wagner, E.J. (2011). The

endocannaboinoid system as pharmacological target derived from its CNS role in energy homeostasis and reward. Applications in eating disorders and addictions. Pharmaceutical, 4, 1101-1136. doi:10.3390/ph4081101


Watson, M.J., Lydecker, J.A., Jobe, R.L., Enright, R.D., Gartner, A., Mazzeo, S.E. and

Worthingtion, E.L. (2012). Self-forgiveness in anorexia nervosa and bulimia nervosa. Eating Disorders, 20, 31-41. DOI: 10.1080/10640266.2012.635561


Wilson, G., Grilo, C., Vitousek, K. (2007). Psychological treatment of eating disorders.

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Now that you have read this section, in “My Mental Health Professional Practitioner Journal” record your answers and reactions to the following questions:

  1. How will this information help me as a Mental Health Professional?
  2. How interested am I in implementing Evidence Based Practices concerning Bulimia in my clinical practice?
  3. Why is it important that I learn more about Bulimia?
  4. What more do I need to know about Bulimia?
  5. Where can I go to obtain more information about Bulimia?
  6. Where can I go to obtain the journal articles, manuals, workbooks or guidebooks on Bulimia?